Healthcare providers and digital health companies face challenges in adopting APIs and integrating with EHR systems. Despite the potential benefits of APIs in improving patient care and expanding EHR capabilities, barriers such as high fees, lack of standardized data, and EHR fragmentation persist. Can the ONC (Office of the National Coordinator) help drive greater API adoption and overcome these obstacles?
The topic was originally discussed in this feature from TechTarget where they explore the current landscape of API adoption in healthcare, the barriers faced by digital health companies, and the impact of recent policy changes. They also discuss the importance of data integrity and the engagement of digital health companies in policy efforts. In this blog, our President and Cofounder, Marilee Benson provides her expert commentary on these critical topics.
Overview of API adoption in healthcare and integration with EHR systems
Application programming interfaces (APIs) have become common in many sectors, such as travel and finance, but their adoption in healthcare and integration with electronic health record (EHR) systems has been slower. However, there is steady progress towards greater API adoption and use in healthcare, driven in part by federal policy initiatives, such as TEFCA and the ONC’s focus on fast tracking FHIR. Additionally, API based healthcare interoperability solutions have recently emerged that bridge the Modern API – legacy standards gap.
“Offering simple but robust API access to the national networks has been a gamechanger for healthcare organizations connecting to eHealth exchange, Carequality and other national networks. Modern engineers demand RESTful APIs. Zen’s Stargate Gateway meets that need by transforming to the legacy standards still widely used by the national networks. Given the high volumes of legacy based exchange happening today, this bridge approach is going to be needed for some time.”
Federal policy driving greater adoption and use of APIs
Recent policy changes, such as the 2015 Edition Cures Update, have made several changes to the ONC Health IT Certification Program, including requirements for FHIR-based standardized APIs for patient and population services. These regulations are helping to drive the adoption of standardized APIs in healthcare.
Preliminary findings from a national survey of digital health companies
A national survey of 104 digital health companies conducted by the Center for Clinical Informatics and Improvement Research (CLIIR) at the University of California San Francisco (UCSF) has revealed preliminary findings on the challenges and barriers to API integration with commercial EHRs. The survey also highlights the impact of recent policy changes on API adoption.
“Seeing that these regulations have had this impact is a powerful story of policy gone right. We should celebrate because it’s not always easy to see that policy has intervened in a productive way.”
Understanding APIs in Healthcare
Definition of API and its role in sending information between users and websites/apps
An API, or application programming interface, is a tool that sends information back and forth between a user and a website or app. APIs allow different systems to communicate and exchange data seamlessly, enabling the development of new applications and services.
Examples of API use in other sectors (e.g., travel, finance)
APIs are widely used in sectors such as travel and finance, where they enable cost comparison and data aggregation from multiple sources. For example, travel services can use APIs to compare flight prices from different airlines without requiring the user to visit each website separately.
Use of apps by patients to monitor health goals and interact with providers
In healthcare, patients are increasingly using apps to monitor their health-related goals and engage with their providers through patient portals. These apps rely on APIs to access and exchange data with EHR systems, enabling patients to take a more active role in their healthcare. Increasingly, the FHIR API, designed specifically for healthcare use cases is the API of choice in the healthcare sector, and is consistent with ONC recommendations.
Use of apps by clinicians to expand EHR capabilities and support patient care
Clinicians are also using apps to expand the capabilities of their EHR systems and provide better patient care. These apps can offer clinical decision support (CDS) tools and access to additional health data, helping providers make more informed decisions and improve patient outcomes.
“For example, some of Zen’s clients offer enhanced provider views when reviewing complex medical histories coming from multiple sources, greatly improving provider productivity and the quality of care. Check out VivlioHealth.com to learn more about their approach.”
Barriers to API Adoption for Digital Health Companies
High fees and difficulty accessing API endpoints as barriers
Digital health companies face several barriers when trying to integrate their applications with commercial EHRs using APIs. High fees charged by EHR vendors and difficulty accessing API endpoints are among the identified challenges that hinder API adoption in healthcare.
Lack of realistic clinical testing data and standardized data elements
Another significant barrier is the lack of realistic clinical testing data and standardized data elements. Without access to high-quality, representative data, digital health companies struggle to develop and test their applications effectively, limiting their ability to create value for healthcare providers and patients.
“If you look at the set of top barriers, like lack of realistic clinical testing data and standardized data elements, a lot of it seems like it’s not about the API. You can get the API to work, but the challenges come in once you’re trying to or working with the data itself.”
Need for a robust understanding of healthcare to integrate commercial EHRs using APIs
Integrating commercial EHRs using APIs requires a deep understanding of healthcare and its complexities. App developers must have knowledge of health conditions, medications, and other domain-specific information to effectively work with healthcare data, making it more challenging than developing applications for other sectors. This is why healthcare interoperabiltiy platforms and services like those offered by Zen Healthcare IT are so frequently utilized by healthcare vendors. This approach allows the healthcare vendor to make the best use of their own development resources, while accessing the interoperabiltiy experts as needed.
“In travel or transportation, you don’t need quite that same level of expertise and knowledge to come up with a product or service that might be useful. Not to say it’s easy, but I just think healthcare is particularly complex.”
Challenges with EHR Data and Data Integrity
Importance of data integrity for value in accessing EHR data
Data integrity is crucial for realizing the value of accessing EHR data through APIs. If the data itself is not of high quality and easy to work with, the potential benefits of API integration are limited, regardless of how well the API itself functions.
Difficulties in fixing data integrity issues and its impact on API integration
Role of policymakers in addressing data integrity issues
Addressing data integrity issues is a complex and challenging task, as it often requires changes at the source of the data, such as improving data entry practices and standardizing data elements across different systems. These difficulties can hinder the success of API integration efforts, even if the technical aspects of the API are functioning correctly.
Policymakers have a role to play in addressing data integrity issues, but it is not an easy task. While technical solutions and standards can help, improving data quality often requires changes in organizational practices and workflows, which can be more difficult to influence through policy alone. ## Impact of Policy Changes on API Adoption ### Overview of the 2015 Edition Cures Update and its impact on API adoption The 2015 Edition Cures Update introduced several changes to the ONC Health IT Certification Program, including requirements for FHIR-based standardized APIs for patient and population services. These changes have had a significant impact on the adoption of standardized APIs in healthcare. 74% of surveyed digital health companies reported using FHIR APIs as required by the regulations.
Requirement for FHIR-based standardized API for patient and population services
The requirement for FHIR-based standardized APIs for patient and population services is a key driver of API adoption in healthcare. By mandating the use of a common standard, the policy helps to reduce fragmentation and improve interoperability between different systems.
Survey findings on the use of standardized APIs and the impact of Cures Act regulations
The preliminary findings from the CLIIR survey highlight the impact of the Cures Act regulations on the adoption of standardized APIs. Half of the respondents (49 percent) reported that the regulations are making it easier for them to provide customers with APIs, demonstrating the positive effect of the policy changes. ## Engagement of Digital Health Companies in Policy Efforts
Subset of digital health companies engaged in policy efforts
While some digital health companies are actively engaged in policy efforts and closely follow the actions of regulatory bodies like the ONC and CMS, others are less involved. This variation in engagement is not necessarily a problem, as the ultimate goal is to create an ecosystem that enables digital health companies to create value and bring solutions to market.
Importance of creating an ecosystem for digital health companies to create value
The primary objective of policy efforts should be to foster an environment that allows digital health companies to develop innovative solutions and bring them to market, creating value for healthcare providers and patients. By addressing barriers to API adoption and promoting standardization, policymakers can help to create such an ecosystem.
Use of proprietary APIs and non-standardized integration approaches
Despite the progress in adopting standardized APIs, many digital health companies still rely on proprietary APIs and non-standardized integration approaches. The survey findings show that more than 60 percent of companies reported reliance on non-standardized APIs and non-API-based integration approaches (69 percent and 65 percent, respectively).
“We’re in this very dynamic time, where we’re still seeing a lot of use of old-style integration approaches, but also a lot of use of the most current FHIR-based APIs.”
Future Outlook and Conclusion
Expectation of older integration methods falling away over time
As the adoption of standardized APIs continues to grow, driven by policy changes and industry trends, it is expected that older integration methods will gradually fall out of use. However, this transition will take time, and we are currently in a period where both old and new approaches coexist.
“In our opinion, It is vital that Digital Health Companies and other healthcare organizations prepare to support a mixed API – Legacy standards ecosystem. If you look at the last 20 years in healthcare tech, the trend is to simply keep adding new data exchange standards without replacing the old ones. Some of this is due to the complexity of thousands of data sharing use cases. One standard is probably not going to meet all needs in the foreseeable future.”
Need for further survey responses to gather more insights
While the preliminary findings from the CLIIR survey provide valuable insights into the current state of API adoption in healthcare, there is a need for further responses to gather a more comprehensive understanding of the challenges and opportunities in this space. The survey aims to collect data from 300 digital health companies, which will help to validate and expand upon the initial findings.
Summary of key findings and takeaways from the article
The article highlights the growing adoption of APIs in healthcare, driven by federal policy initiatives such as the 2015 Edition Cures Update. However, digital health companies still face significant barriers to API integration with commercial EHRs, including high fees, lack of standardized data, and EHR fragmentation. Data integrity issues also pose a challenge, and addressing these issues requires a concerted effort from policymakers, healthcare organizations, and digital health companies. Despite these challenges, the survey findings demonstrate the positive impact of recent policy changes on API adoption and the importance of creating an ecosystem that enables digital health companies to create value for healthcare providers and patients.
Conclusion
In conclusion, the adoption of APIs in healthcare is a complex and evolving landscape, with both challenges and opportunities for digital health companies and healthcare providers. Federal policy initiatives have played a significant role in driving the adoption of standardized APIs, but barriers to integration with commercial EHRs persist, including data integrity issues and the need for a deep understanding of healthcare complexities. To fully realize the potential of APIs in healthcare, it is essential to address these challenges through a combination of policy efforts, industry collaboration, and technological innovation. By creating an ecosystem that enables digital health companies to develop and bring innovative solutions to market, we can improve patient care, expand EHR capabilities, and drive the digital transformation of healthcare. As the industry continues to evolve, it is crucial for digital health companies, healthcare providers, and policymakers to work together to overcome the barriers to API adoption and harness the power of data to improve healthcare outcomes for all.
